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Mupirocin prophylaxis against methicillin-susceptible, methicillin-resistant, or vancomycin-intermediate
A Giacometti1, O Cirioni, R Ghiselli
1Institute of Infectious Diseases and Public Health, University of Ancona, Ancona, Italy. cmalinf@popcsi.unian.it
Abstract:
A rat model was used to investigate the efficacy of mupirocin in the prevention of vascular prosthetic graft infection due to Staphylococcus epidermidis strains with different susceptibility patterns (methicillin susceptible, methicillin resistant, and with intermediate resistance to vancomycin). The effect of mupirocin-soaked Dacron was compared to that of perioperative intraperitoneal prophylaxis with vancomycin. Graft infections were established in the back subcutaneous tissue of adult male Wistar rats by implantation of Dacron prostheses (1 cm(2)) followed by topical inoculation with 5 x 10(7) CFU of one staphylococcal strain. The study included a control group (no graft contamination), three contaminated groups that did not receive any antibiotic prophylaxis, three contaminated groups that received mupirocin-soaked grafts, three contaminated groups in which perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg of body weight) was administered, and three contaminated groups that received mupirocin-soaked grafts and perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were sterilely removed 7 days after implantation, and the infection was evaluated by using sonication and quantitative agar culture. Data analysis showed the efficacy of mupirocin against all three strains, with growth of the strains in treated rats significantly different than that in the untreated control. In addition, mupirocin was more effective than vancomycin against the strain with intermediate susceptibility to the glycopeptide. Finally, the combination of mupirocin and vancomycin produced complete suppression of the growth of all of the strains.
Insights
Mupirocin effectively prevents vascular prosthetic graft infections caused by Staphylococcus epidermidis. This antibiotic proved superior to vancomycin in some cases and, when combined, completely suppressed bacterial growth.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Innovation
Background:
- Vascular prosthetic graft infections pose a significant clinical challenge.
- Staphylococcus epidermidis is a common pathogen in these infections, exhibiting varied antibiotic resistance patterns.
- Novel strategies are needed to prevent graft infections effectively.
Purpose of the Study:
- To evaluate the efficacy of mupirocin in preventing Staphylococcus epidermidis vascular prosthetic graft infections in a rat model.
- To compare mupirocin-soaked grafts with vancomycin prophylaxis.
- To assess the combined effect of mupirocin and vancomycin.
Main Methods:
- A Wistar rat model was utilized, involving Dacron graft implantation and inoculation with Staphylococcus epidermidis strains.
- Experimental groups included controls, antibiotic prophylaxis (mupirocin-soaked grafts, intraperitoneal vancomycin), and combination therapy.
- Graft infection was quantified via sonication and agar culture 7 days post-implantation.
Main Results:
- Mupirocin demonstrated significant efficacy against all tested Staphylococcus epidermidis strains compared to untreated controls.
- Mupirocin outperformed vancomycin against a vancomycin-intermediate susceptible strain.
- The combination of mupirocin and vancomycin achieved complete suppression of all tested strains.
Conclusions:
- Mupirocin is a viable option for preventing vascular prosthetic graft infections.
- Mupirocin offers advantages over vancomycin for specific resistant strains.
- Combined mupirocin and vancomycin therapy provides robust protection against graft infections.